How is “disability” defined and determined by Social Security?

For Social Security purposes, “disability” is defined as the “inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or has lasted or can be expected to last for a continuous period of not less than 12 months.” The determination must be based on medical evidence that describes the severity of the impairment. Sometimes the claimant’s work history is relevant evidence in a “disability” determination as well.

The SSA’s regulations provide for disability evaluation by a process called the “sequential evaluation process.” For adults, this process requires sequential review of the claimant’s current work activity, the severity of his or her impairment(s), a determination of whether his or her impairment(s) meets or medically equals a listing (see below for information on Listings), the claimant’s residual functional capacity, his or her past work, and his or her age, education, and work experience. For children applying for SSI, the process requires sequential review of the child’s current work activity (if any), the severity of his or her impairment(s), and an assessment of whether his or her impairment(s) results in marked and severe functional limitations. If an adult or child is found disabled or not disabled at any point in the evaluation, the evaluation ends at that point.

5-Step Sequential Evaluation Process:

Step 1 – Are you working (engaging in “substantial gainful activity”)?

“Substantial” means doing work involving “significant physical or mental activities.” If you cannot handle simple, ordinary tasks without supervision or assistance, then your work activity may not be considered substantial. The analysis of “gainful” usually depends on earnings, although for self-employed claimants the analysis will change. In 2011, if you worked and your earnings averaged more than $1,000 a month, you generally cannot be considered disabled. If the SSA finds you are engaging in “substantial gainful activity,” you are not disabled. If the answer is no, you can proceed to Step 2.

Step 2 – Is your impairment “severe”?

For your impairment to be severe, your condition must interfere with basic work-related activities. Your condition may be physical, mental, or a combination of both. The duration of your impairment must either be expected to result in death or be expected to last for a period of twelve (12) consecutive months. If the SSA determines that your condition does interfere with basic work-related activities, the SSA will then proceed to step 3.

Step 3 – Is your condition in the Impairment Listings (a list of disabling conditions)?

The Listing of Impairments describes impairments that are severe enough to prevent an individual from doing any gainful activity for each major body system (or in the case of children under age 18 applying for SSI, severe enough to cause marked and severe functional limitations). The Listing of Impairments criteria apply to both the Social Security disability insurance program and the SSI program. If your condition is not found in the Listings, it still is possible that the SSA can find that your impairments, or a combination of them, are “equivalent” in severity to an impairment in the Listings. If your impairment is on the Listings or determined to be medically equivalent to a Listing, the SSA will find that you are disabled. If it is not, your claim is not over yet; you move on to Step 4.

Step 4 – Can you do the work you did previously?

If your condition is severe but not at the same or equal level of severity as a medical condition in the Listings, the SSA must determine if it interferes with your ability to do the work you used to perform. The SSA makes this determination by assessing your remaining ability to do basic work functions and comparing them with the demands of your recent past work. The SSA only looks at your past work that it considers relevant to this decision. This usually means work that (i) you did in the 15 years before your case is decided, (ii) involved significant and productive physical or mental activities that was done or intended for a profit, and (iii) was done long enough for you to learn how to do it. If the SSA decides that the past work you did is relevant, it then compares your current residual functional capacity for work with the demands of the past relevant work. If the SSA decides that you can still perform your past work in the same way you did it or in the same way it is done in the national economy, it will find that you are not disabled and your claim will be denied. On the other hand, if the SSA decides your condition does not allow you to do past relevant work that you did previously or as it is done in the national economy, your claim will proceed to Step 5.

Step 5 – Can you do any other type of work?

If you cannot do the work you did in the past, the SSA determines if you are able to adjust to other work. In making this determination, it considers your age, your medical conditions, your education, past work experience and your working capacity. If you cannot adjust to other work, your claim will be approved. If you can adjust to other work, your claim will be denied. The SSA relies on The Medical-Vocational Guidelines, which are tables otherwise known as “the Grids” to make this determination. The older you are, the better the chance you will be found disabled according to the Grids.